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58 Fighting the Diseases of Poverty
Politicisation of health care
As the government health sector is under political control, the views
of key government officials on a particular medical issue directly
affect the manner in which the government health sector deals with
it. The views of the South African President and Minister of Health
on HIV/Aids are considered to have been the main reason 12 for the
country’s slow response in dealing with the HIV/Aids problem
despite the government’s commitment 13 to decreasing the incidence
of infection.
In a government planned and controlled health system, patients
are at the mercy of politicians and those appointed by them to
control the system.
The “free health care” myth
Government health policy entitles certain categories of patients,
including pregnant women and children younger than six years of
age, to receive “free” general care, while “free” primary health care
is available to every citizen (Health Systems Trust, 2004). However,
the health care is not free. It is provided to patients at the expense
of the taxpayer.
The day after Nelson Mandela, during his presidency, announced
that “all pregnant women and children under the age of 6 years”
would be entitled to “free” health care; some public hospitals could
not cope with the large number of women and children who arrived
on their doorstep seeking medical care. The event dramatically
demonstrated that if the cost is reduced, especially if it is reduced
to zero, the demand increases exponentially. To cope with this
demand, government health-care providers have no option but to
reduce availability or deny health care to patients.
However, the difficulties that arise as a result of the introduction
of so-called “free” care are not limited to rationing – it also means
less efficient and more expensive health care (Reisman, 1996). A
large bureaucracy is needed to administer a socialised health
system, which together with the built-in bureaucratic inefficiencies,
add even more to the costs of so-called “free” health care. To control